Procalcitonin Biomarker for Sepsis in Postoperative Pediatric Trauma Patients: Three Years of Experience from a Tertiary University Hospital

Background: The biomarker procalcitonin (PCT) is good in detecting sepsis in postoperative pediatric trauma patients, especially those with a high suspicion of sepsis, and formulating a quick treatment. Its use is still limited to pediatric surgical patients, particularly those in intensive care units (ICUs), who are more susceptible to sepsis. The purpose of this study was to see if procalcitonin could be used as a reliable and quick biomarker for sepsis in postoperative pediatric trauma patients and were brought to the PICU. Methods: This retrospective longitudinal study was conducted from January 2017 to December 2019. Postoperative pediatric trauma patients aged > 2 weeks old who were hospitalized at the PICU of King Fahd Hospital of the University due to serious trauma or post-acute surgical events were included. Within 24 hours of admission, PCT levels were measured, and again 48-72 hours later. Results: In our study, 31% of severely ill children developed post-surgical sepsis. When compared to the PRISM III score and 24-hour PCT level, PCT levels at 48-72 hours exhibited the largest area under the curve (AUC). With a sensitivity of 71% and a specificity of 65%, the predictive AUC value was estimated to be 0.71. The AUC of PCT levels at 48-72 hours was 0.72 (95% confidence interval (CI): 0.65-0.79; p < 0.001), indicating high predictive validity using a cutoff point > 0.10, with sensitivity, specificity, and positive and negative predictive values of 68.4%, 63.6%, 45.8%, and 81.8%, respectively. Conclusion: PCT is a sensitive biomarker for detecting sepsis in postoperative pediatric trauma patients, especially those with a high pre-test suspicion for sepsis. In addition, PCT can be used alone or in combination with other clinical findings to help formulate a rapid primary diagnosis of sepsis in this subset of patients.